长短周期现象触发快速室性心律失常诊断价值研究

发布时间：2018-03-23 19:50

  本文选题：长短周期现象　切入点：快速性室性心律失常　出处：《广州中医药大学》2017年硕士论文

【摘要】：目的:通过对动态心电图诊断快速性室性心律失常病例观察研究,分析其常见诱发因素,测量室早前RR间期、联律间期、两者比值,对比分析触发快速性室性心律失常的室早的特征,探讨室早合并的或房颤自发形成长短周期现象与快速性室性心律失常的发生及其连缀现象的相关性,从而深入地了解快速性室性心律失常的触发和维持机制,为临床评估室性心律失常危险分级提供更多客观的参考指标,有助于临床上更好地防治快速性室性失常事件的发生。方法:收集动态心电图诊断存在快速性室性心律失常病例(50例)作为观察组,另外选择同期行动态心电图诊断为单发室早无伴发快速性室性心律失常病例(49例)作为对照组,选取两组动态心电图中数据进行对比分析,统计分析快速性室性心律失常的常见触发因素,并分别测量两组室早的前RR间期、联律间期、两者比值,比较两组间是否存在统计学差异性,进一步选取两组间存在长短周期现象病例进行统计分析,评价长短周期现象对触发快速性室性心律失常的相关性。将观察组分为存在连缀现象组和非连缀现象组,统计分析合并长短周期现象室早触发的快速性室性心律失常是否更加容易发生连缀现象,通过观察快速性室性心律失常发生前后的心电图特征分析,进而探讨快速性室性心律失常的触发和维持机制。成果:两组动态心电图数据对比分析结果显示,(1)观察组50个病例中共发生快速性室性心律失常531阵,其中490阵/次(92.28%)由室早触发;(2)观察组中室早的前 RR 间期较对照组明显延长(909.73+283.22ms、786.63±151.23,P0.05),联律间期也较对照组延长(541.37±111.49ms、497.01±78.75,P0.05),但两者比值较对照组较小(0.63±0.14、0.65±0.11,P0.05);(3)观察组中短联律间期(≤430ms)发生率较对照组稍低(13.06%、18.68%,P0.05);(4)观察组中长短周期现象(≥735ms)发生率明显高于对照组(70.00%、60.68%,P0.05);(5)观察组中由长短周期现象触发快速室性心律失常病例发生连缀现象较无长短周现象者发生率更高(58.33%、21.43%,P0.05);(6)两组合并房颤病例数具有统计学差异(20.00%、4.08%,P0.05),其中以观察组发生例数较多,包括房颤者10例,其中包括9例形成长短周期现象并触发快速性室性心律失常52阵,另外1例在房颤终止2小时后出现反复室颤形成心电风暴。结论:室早是临床上发生快速性室性心律失常(室性心动过速、心室扑动、心室颤动)的常见触发因素,尤其合并长短周期现象者触发风险更高,且长短周期现象中长心动周期延长越明显,其触发几率越高,同时长短周期现象还具有触发快速性室性心律失常反复或持续发作形成连缀现象,从而诱发恶性室性心律失常的风险。房颤因其具有心律绝对不整的特点,可以自然形成长短周期现象而触发快速性室性心律失常,提示房颤可能亦具有触发恶性室性心律失常的风险。
[Abstract]:Objective: to analyze the common inducing factors of ambulatory electrocardiogram in the diagnosis of tachyarrhythmia, and to measure the early RR interval, synhythmic interval and the ratio of them. To compare and analyze the characteristics of ventricular premature triggered by tachyarrhythmia, and to explore the correlation between the occurrence of premature ventricular arrhythmias and the occurrence of tachyarrhythmias, and the relationship between the spontaneous formation of long-cycle of ventricular premature arrhythmias or atrial fibrillation and the occurrence of tachyarrhythmias. In order to understand the trigger and maintenance mechanism of tachyarrhythmia, and provide more objective reference index for clinical evaluation of risk classification of ventricular arrhythmia, Methods: 50 cases of tachyarrhythmia diagnosed by dynamic electrocardiogram were collected as observation group. In addition, 49 cases of single ventricular premature ventricular arrhythmias diagnosed by ambulatory electrocardiogram (DECG) were selected as the control group, and the data of the two groups were compared and analyzed. The common trigger factors of tachyarrhythmia were statistically analyzed, and the preRR interval, synhythmic interval and ratio between the two groups were measured, and the statistical differences between the two groups were compared. In order to evaluate the correlation of long-period phenomenon to trigger tachyarrhythmia, the observation group was divided into two groups: the group of continuous phenomenon and the group of non-continuous phenomenon. Statistical analysis was made on whether tachyarrhythmias triggered by premature ventricular arrhythmias were more likely to occur contiguous phenomenon, and electrocardiogram characteristics were analyzed before and after the occurrence of tachyarrhythmias. Results: a comparative analysis of two groups of dynamic electrocardiogram data showed that a total of 531 tachyarrhythmias occurred in 50 cases in the observation group. The anterior RR interval in the observation group was significantly longer than that in the control group (909.73 283.22ms / min 786.63 卤151.23mg / kg P0.05N), and the combined rhythm interval was also prolonged (541.37 卤111.49ms) 497.01 卤78.75mg / min, but the ratio of the two was 0.63 卤0.140.65 卤0.11P0.05P0.03s (鈮，

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